Medical Machers Ask: Should Guns Be Part of Patient Profile?

If Jeremiah Barondess, the patrician elder statesman of the

New York medical community, has his way, the average doctor’s examination in

the near future will include questions not only about a patient’s consumption

of red meat and alcohol, but of ammunition, too. Dr. Barondess, who is

president of the august New York Academy of Medicine, thinks physicians should

know if their patients have guns in the house. Some 600,000 doctors nationwide

are seconding that opinion.

Under Dr. Barondess’ direction, an organization representing

approximately two-thirds of the practicing doctors in America is about to

inject itself into the national debate on gun violence. Inviting the wrath of

the gun lobby, the group not only will advocate further gun regulation, but

will urge doctors to ask their patients specific questions about guns in their

homes and tell them about the risks of gun ownership.

The Observer

obtained a copy of a report put together by the ad-hoc coalition called Doctors

Against Handgun Injury. In it, the group recommends that health professionals

engage in what it calls “upstream intervention”-that is, using regular checkups

as an opportunity to ask patients about firearm ownership and storage in their

homes. “To promote public safety, health professionals and health systems

should ask about firearm ownership when taking a medical history or engaging in preventive counseling,” the report

states. “Patients should be provided with information about the risks of having

a firearm in the home, as well as methods to reduce the risk, should they

continue to choose to keep them.” The recommendation was based on an analysis

of recent gun-related suicides, homicides and accidental deaths across the

country.

The group is also calling for more conventional measures,

such as mandatory background checks of purchasers at gun shows, limits on the

number of guns that can be purchased by individuals and a waiting period for

all gun buyers. This is the first time that such a large group of doctors has

taken a position on gun control. Doctors Against Handgun Injury is made up of

the American Medical Association, the American Psychiatric Association, the

American Academy of Pediatrics and 10 other organizations.

Dr. Barondess, an author and medical-school professor with a

reserved demeanor and a taste for starched shirts, tried to minimize the

political fallout over his group’s report, describing the findings as purely

clinical. “We are neutral politically, academically and intellectually,” he

said. “Without politicizing this, it is possible for medical professionals to

proselytize for this and point out the dangers of gun violence. Getting shot

and being dead is certainly a clinical issue.”

Whatever the group’s intentions, the recommendations come in

the wake of yet another public-school shooting-the early March incident in

Santee, Calif., in which two students were killed. The double murder, allegedly

carried out by a 15-year-old student armed with a handgun, has been seized upon

by both sides in the contentious debate over gun regulation. And while the

timing is coincidental, one of the organizers of Doctors Against Handgun Injury

conceded that the report is almost certain to provoke strong reactions all

around, and stiff resistance from the gun lobby in particular.

“The National Rifle Association will probably say that we’re

threatening gun rights, no matter what,” said Robert Seltzer, the group’s

executive director, who worked for almost two decades on Capitol Hill for a

number of Democratic Senators. “I’m sure they’ll say this is disgusting and

wrong and bad, and that we’re trying to take away people’s guns-which we’re

not.”

The proposals are

expected to receive strong support from New York physicians. “Disability and

death from injury are the No. 1 problem for children and young people in United

States, and a major piece of that is guns, so any objections wouldn’t even

register with me,” said Katherine Lobach, a clinical professor of pediatrics at

Montefiore Medical Center in the Bronx. “I would hardly see it as a problem

that doctors would be concerned with gun violence. I certainly hope that this

becomes common practice.”

It may, but certainly not without a fight in those parts of

the country where the gun culture is more prevalent. “I think in New York this

will all be pretty easy, but out west and even upstate, people and guns are a different

story,” Dr. Lobach said.

The gun lobby already staunchly opposes one seemingly benign

recommendation which would not directly affect gun owners-the collection of

data on gun accidents by the federal government. (Such a program was created in

1992, but funding was discontinued by Congress in 1997 after heavy lobbying by

the N.R.A.) Wayne LaPierre, the executive vice president of the N.R.A., has

described such measures as the “knock on the door in the middle of the night”

that will inevitably lead to tighter restrictions or even a ban on the

ownership of guns.

The doctors’ report also is likely to face opposition from

at least one group within the medical community. Doctors for Responsible Gun

Ownership claims a membership of about 1,300 physicians and exists, according

to its Web site, “because social activists in the medical and public health

fields have used their authority to misrepresent gun ownership as a disease.”

Dr. Tim Wheeler, who heads Doctors for Responsible Gun Ownership, assailed the

recommendations of the newly formed coalition. “The reason that this group is

getting involved in gun politics has nothing to do with public health,” Dr.

Wheeler told The Observer from his home in California. (The N.R.A. referred calls

about Doctors Against Handgun Injury to Dr. Wheeler.) “Handgun ownership is not

a medical issue and never has been, but is politicized by political activists

and medical organizations. Most of the useful scientific research on handguns

is not in the medical field but in criminology, and these medical groups have

not only ignored but suppressed this information.”

Dr. Wheeler expressed

particular alarm at the prospect of doctors mixing lectures about gun ownership

into the standard checkup routine. “This is a real hot-button privacy issue,”

he said. “When doctors talk about guns for political purposes, they are

committing an unethical act, and their patients who are responsible gun owners

feel violated. Most of these doctors don’t know squat about guns. They don’t

know anything about personal safety, and they’re usually very hostile to gun

ownership for political reasons.”

Dr. Barondess’ vigorous assertions of respect for gun

owners’ rights-in an interview, he noted several times that many of the doctors

in his coalition owned firearms-may do little to assuage the likes of Dr.

Wheeler. But if he is in for heavy combat, Dr. Barondess will have some

experience on his side. He is no stranger to controversy.

Washington’s Dentures

Dr. Barondess was responsible for transforming the 153-year-old

New York Academy of Medicine from a sleepy repository for medical

antiquities-the medical library at its East 103rd Street headquarters boasts

both a 3,700-year-old papyrus and a set of George Washington’s dentures-into an

active policy organization. A 76-year-old native New Yorker, a professor of

clinical medicine at Cornell University Medical College and a co-author of The Oxford Medical Companion , he has

used his stature to weigh in on an array of issues and thus raise the Academy’s

profile.

Over the last decade, Dr. Barondess has spoken out on such

issues as care for AIDS victims and hospital conditions for the urban poor.

Most recently, he fueled a national debate over ergonomic standards in the

workplace, when a panel he chaired issued a report on the scientific basis for

such rules in January. Both the report-carried out under the auspices of the

National Academy of Sciences-and Dr. Barondess’ subsequent testimony before

Congress have been cited by unions, business groups, U.S. Representatives and

the federal Occupational Safety and Health Administration in support of their

arguments. Just before leaving office, former President Clinton issued new

regulations requiring employers to take action to prevent such ailments as

repetitive-stress syndrome. Congress overturned those regulations in early

March.

Dr. Barondess also gained attention in 1996 when he implored

Supreme Court Chief Justice William Rehnquist to prohibit the legalization of

doctor-assisted suicide. Before that, Dr. Barondess made his first major push

into the area of gun violence, declaring on behalf of a coalition of New

York–based medical officials that it had become an “epidemic” in the city and

surrounding area.

Dr. Barondess’ statements, whether on gun violence or

medical care in the inner city, appear to have a common thread: an expansion of

the medical community’s role in shaping public policy. “We are in the business

of helping to redefine health in ways that would include any kind of

population-based risks like, for example, handguns and workplace injuries,” he

said.

With his Doctors Against Handgun Injury, however, Dr.

Barondess has embarked on his biggest undertaking ever. He believes that the

coalition will be by far the largest organization of doctors ever to offer a

unified opinion on such a contentious issue. And although he refuses to discuss

something as vulgar as political considerations-”Let’s just say that some

political figures appreciate what I have to say more than others,” he

remarked-he can hardly doubt that, with George W. Bush in the White House and

Republicans in control of Congress, most of his group’s recommendations are

unlikely to become law anytime soon.

But Dr. Barondess believes that his group may be able to

change the tenor of the discussion over gun violence. “This is not in any way

about gun control,” he said. “We can think of handgun injury as being like a

disease that afflicts many people in our society, and we’re going to introduce

mandatory immunizations for this disease. Part of this mayhem is preventable,

and doctors are in the prevention-of-premature-death business. The number of

people killed by guns every year is indisputable, and criminal justice is not

the only way of solving this.”